The fundamental mission of academic medicine is the acquisition and application of scientific knowledge to improve health care. In order for the medical enterprise to function effectively, it is critically important for the academic biomedical community to have physician-scientists who receive special training that integrates both a rigorous scientific education with state-of-the-art medical education. These individuals facilitate interactions between the clinic and lab that promote both basic investigation on disease mechanisms and translational research leading to clinical applications. Thus, they are positioned to be leaders in biomedical research and educational communities. The Ohio State University (OSU) Medical Scientist Training Program (MSTP) was initially funded to achieve these lofty goals in 2011. In this renewal application, we describe the outstanding MD-PhD training program we have developed, which provides rigor, depth, and breadth of both scientific and medical education in a way that facilitates the integration of both sets of training to prepare these dedicated and driven students for careers as successful physician-scientists. Over the preceding grant period, the OSU MSTP has served as a partnership program linking medical school curriculum with three integrated core graduate programs during a time of tremendous curricular evolution. By working closely with medical school and graduate school leadership, we have used new approaches in both areas to develop a cutting-edge curriculum joining foundational knowledge with in-depth scientific inquiry in a wide variety of areas. Medical school coursework is completed using an MSTP-specific modification of OSU's Lead. Serve. Inspire (LSI) curriculum, a competency-based, efficient approach which eschews large lectures in favor of self-directed learning, high-yield student-faculty contact hours, and early, meaningful, patient contact. PhD courses begin in the second year of the program. The prior grant allowed students to earn their degrees in the Biomedical Sciences Graduate Program (BGSP), Neuroscience Graduate Studies Program (NGSP), or Biomedical Engineering (BME). In this proposal, we make good on our plan to expand PhD availability across the University to carefully vetted affiliate programs, leveraging our campus strength in non-traditional, but highly relevant graduate programs. Because of our curricular integration and careful oversight by MSTP Leadership, students complete their studies in a time-efficient manner, typically 8 years. Our innovative MD-PhD program has attracted interest from an outstanding pool of applicants that has doubled in size over the past 5 years concurrent with a doubling in size of our matriculating class from 5 to 10 students per year. Herein we request funds to double our NIH-supported training slots in graded fashion to match this growth. Renewal: students, developing future leaders who will enable the Ohio State University Wexner Medical Center to achieve its stated mission: To improve people's lives through innovation in research, education and patient care.